Hemodialysis-associated carpal tunnel syndrome. A clinical review

The clinical features of 88 patients who developed carpal tunnel syndrome (CTS) in association with end stage renal failure and chronic hemodialysis were studied (11 original cases and 77 collected from the literature). Hemodialysis-associated CTS was found to have a 2 to 1 male predominance, to occur more often in angioaccess-bearing (86%) than in unoperated arms (48%) (p = 0.005), and to require surgical release of the median nerve in most of the cases (86%). The analysis of 48 of these patients revealed two patterns of presentation. Patients with the 'early pattern' (41.6%) developed CTS within 1 year of commencing hemodialysis; diabetes mellitus and/or severe polyneuropathy were present in at least 40%. In contrast, patients with the 'late pattern' (58.4%) developed symptoms after at least 1 year on hemodialysis; diabetes mellitus and/or polyneuropathy were present in less than 10%. CTS should be considered in any hemodialysis patient with upper extremity neurological symptoms; early diagnosis and treatment will prevent loss of hand function.